RCxRules HCC Coding Software automatically reviews 100% of the diagnosis codes coming out of your EMR to ensure full HCC capture for the most accurate RAF scores.
Schedule 1:1 Meeting"In a single week we saw an additional $100K+ in otherwise missing RAF value by using the RCxRules HCC Coding Software. With RCxRules, we were easily able to scale up with value-based contracts. The value of RCxRules software is unprecedented—in fact, it's a necessity for any organization with risk-based contracts."
Using HCC coders alone is a cost-prohibitive way to improve HCC capture and re-capture rates. RCxRules automated HCC coding software dramatically increases coder productivity by identifying and directing only those high-value encounters with HCC coding gaps to coders for review—all before a claim is submitted.
"The automation RCxRules brought to our HCC coding process led to a dramatic productivity hike in our organization and is a key factor in our success with MSSP. The technology is extremely user friendly and the RCxRules team is flexible and responsive."
RCxRules identifies value-based encounters and reviews those encounters for HCC coding gaps. The software compares diagnosis codes to historical HCCs as well as suspected HCCs from population health management software or a payer.
If there’s a missed HCC code, your coders can review and correct the diagnosis code before it’s submitted as a claim.
Retrospective chart reviews are manual and expensive. RCxRules' instantaneous coding workflow reviews encounters before they are submitted as a claim to ensure accurate HCC capture the first time.
Track HCC improvements with real time insights into the HCCs added or deleted by your coders. See how the software pays for itself within the first few months.
Your success is our success. We pride ourselves on the quality of our implementations and support. A dedicated account manager will work with you to optimize the software so you can reach your goals.
RCxRules complements your population health management software. Population health systems do a great job identifying high-risk patients and even identifying missing HCC codes. RCxRules takes this critical data and incorporates the information directly into the coding workflow. RCxRules' focus is on improved HCC coding capture rates and ensuring accurate HCC codes are documented before they’re submitted as a claim. This focus on the HCC coding workflow and concurrent review is outside the scope of the leading population health solutions in the market.
We firmly believe that robust pre-visit planning is essential to any successful HCC coding strategy. If you already have a process in place that works well for you, that’s great. RCxRules' HCC coding workflow easily complements a variety of pre-visit planning strategies. Regardless of the approach, RCxRules' essential value proposition is automating the review of all patient encounters (through concurrent HCC review) to ensure the expected HCC codes were actually captured and will be transmitted to the payer.
A retrospective HCC coding review process occurs after the initial claims have been submitted to a payer. While this process is helpful, it’s typically a highly manual process and requires the review of encounters twice (once for the initial claim and again for the retrospective review). Additionally, the process for submitting the newly identified codes through an alternate submission methodology (ASM) takes time and effort. RCxRules' approach to HCC coding is to quickly and efficiently address this on the front end. We enable HCC coders to review claims in real time so accurate HCC coding is captured on the initial claim submission.
No, RCxRules lets your team focus on what they do best. Your providers can continue providing excellent patient care, while coders work out of RCxRules in a process that supports the providers' clinical documentation efforts. Within RCxRules, coders review HCC coding errors before claim submission.
No, RCxRules is designed for the HCC coding process and the standard fee-for-service coding process to function smoothly and efficiently together (see our Revenue Cycle Rules solution). Our HCC coding solution isolates only those HCC encounters needing coder review and directs to a dedicated HCC coding queue. This workflow mirrors the automated review of traditional fee-for-service claims for accuracy before claim submission implemented by virtually all revenue cycle operations.
RCxRules has the built-in intelligence to detect data issues in risk-based patient encounters and fee-for-service-based encounters and to automatically direct to the appropriate teams for resolution.
RCxRules can capture patient historical HCC codes from a variety of sources. The majority of customers provide the patient’s HCC history from their EMR and revenue cycle management systems. Additionally, many customers will supplement this HCC data with information from their population health management system, or from HCC information their payers can provide to them directly.
The RCxRules HCC coding solution is designed to fully complement your existing population health, EMR, and revenue cycle management systems. RCxRules has a variety of industry standard methods for achieving this integration and our focus is always on using the simplest approach required to meet your needs.
RCxRules has integrated with most major EMR and revenue cycle management systems. This list includes Epic, Cerner, Allscripts, GE, Athena, NextGen as well as many others. Contact us with specific integration questions.